Why...

I totally realize that no where in God's word did he promise life would be easy. I am Jeremy's mom and biggest advocate. I have to pursue with my heart until I feel GOD has closed the door or I win.

We are scheduled to see Dr. Dan in Columbia, MO next Thursday for our appointment, he is the other physician we will be seeing about fixing Jeremy's spine. I found him after seeing Dr. Bridwell in St. Louis, MO and just not having a good feel about the whole situation. I found Dr. Dan by going to the Missouri Parent 2 parent who matched me up with another mom who had a child similar to Jeremy and she told me about him and couldn't say enough good about this man. I started my personal research like I always do, what I've read Dr. Dan is a truly compassionate physician. I've talked to his medical assistant, Holly who has been awesome in setting this all up. I sent Jeremy's X-rays to him, he has looked them over and ready to discuss plans. Their hospital social worker got me set up to stay at the Ronald McDonald house when we go for our visit, if they are full she will give me a voucher for a motel. So, this all sounds great, right, so what is my problem? getting Oklahoma medicaid to approve the out of state visit, there is lot of hoops to jump through. We have a caseworker through medicaid who is working above and beyond to get this done, she has a referral letter from our Pediatrician to see Dr. Dan, medical records from our Orthopedic surgeon referring us out, Dr. Phillips who we seen in Tulsa referring us to Dallas-Scotish Rite or Mo. Her next step is to put this all in a packet with a contact person from the University of MO to go to medical review, if approved it then goes to the contract department to get in touch with the person from the University of MO to make the agreement with. When she called the University of MO, to get that information the lady who would do the contract told her they do not accept out of state medicaid. So all this documentation sits because in the eyes of medicaid if they aren't willing to accept their offer there is no sense in doing all of this work. I asked her, can we not go ahead and send this all though, let it go to medical review to get that determination, let contract come up with a cost and make an offer to the University of MO and then let them accept or deny. This is not an option with medicaid. I call Holly in Dr. Dan's office who is his medical assistant, she is going to talk to Dr. Dan to see if he knows someone who might be willing to get it where they will accept the out of state medicaid for Jeremy's case. She says he truly has a passion for these children and wants to help children like Jeremy who are complex. Our other option would be to get with financial services and see after my insurance BCBS pays if they will give us a discount to lower the cost, and we would make payments. This is going to be a fairly expensive surgery. I emailed Holly to see if the contact person from the University of MO, could call our caseworker and tell them they would consider a contract so this could all go through the process, then we could get a determination, and a contract price. There is a good chance with the budget shortfall that OHCA will say this can be done in OKC and not even approve the request. I can see this happening but feel I have a fairly good case to prevent it from happening, plus I'm prepared to battle the cause. I know my Oklahoma State Rep very well, and he knows me and Jeremy, he has also helped me in the past on some insurance issues and finally got BCBS to give me an exact amount they would pay on J's device. I am going to email him tomorrow to see if he can get medicaid to push this through the system to see if we can get the approval and a contract price.
Our appointment is next Thursday and there is a chance this will not happen before that time so I will more than likely be paying the out of pocket for this consultation and it and it being a new year Jeremy hasn't had a doctor visit yet so he's not met his deductible. The thing is this battle is all for the doctor visit, if that is where he has surgery we start this all over, but I feel if we can get it approved for the office visit the surgery won't be this ordeal. This is frustrating to me as I kept BCBS as my primary health insurance for Jeremy, so I pay the monthly premiums and medicaid is secondary and they only have to pay 20% and feel they can do this, I also feel I'm helping them out by keeping BCBS primary. I'm prepared to pay this office visit, but again don't feel I should and this is the approach I'll take with my State Rep to plead on his mercy.

My prayer is, GOD show me if Dr. Dan is the physician we need to see and pursue to do the surgery. I won't know until we meet him, what his plan is and if he's the one. If this is the place it will work out and I will move mountains & fight a bear to make this happen.